PANIER DE NOËL – Coopération Intégration Canada

Christmas basket

Vous habitez à Ottawa et vous souhaitez bénéficier d’un panier de Noël gratuit ou d’un chèque cadeau échangeable ? Ce programme est pour vous !

Contactez-nous avant le 20 novembre et partagez cette annonce dans votre communauté. Nous serons heureux de vous servir !

Program funded by:

This program is only open during Christmas

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First Name

Last Name

Date de naissance

Phone Number

Langue de communication Préférée

French
English

Is the client's address a co-op or apartment building?

If yes, please enter the alarm or bell number here:

Is it a shelter or a shared apartment?

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Does the client have a spouse or partner?

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If yes, please enter their email

Last Name

If yes, please enter their phone number

Nombre d'enfants (0 à 17 ans)

Please enter the name(s), gender(s) and age(s) of all children in the household

Nombre total d'adultes (18 à 54 ans)

Please enter the name(s), gender(s) and age(ies) of all seniors in the household: (If applicable – Include the client listed in the primary information section):

Nombre total d'aînés (55 ans et +)

Please enter the name(s), gender(s) and age(ies) of all seniors in the household: (If applicable – Include the client listed in the primary information section):

Other information:

Backers of funds

Partners